Provider Demographics
NPI:1922551621
Name:CENTRAL VIRGINIA FAMILY PHYSICIANS
Entity Type:Organization
Organization Name:CENTRAL VIRGINIA FAMILY PHYSICIANS
Other - Org Name:CVFP MADISON HEIGHTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:STAFF CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-382-1139
Mailing Address - Street 1:118 OAKWOOD DR
Mailing Address - Street 2:#A
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:24572
Mailing Address - Country:US
Mailing Address - Phone:434-338-7780
Mailing Address - Fax:434-338-7781
Practice Address - Street 1:118 OAKWOOD DR
Practice Address - Street 2:#A
Practice Address - City:MADISON HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:24572
Practice Address - Country:US
Practice Address - Phone:434-338-7780
Practice Address - Fax:434-338-7781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC03658Medicare PIN